AB1676 REASSESSMENT OF THE SIGNIFICANCE OF PATIENT GLOBAL ASSESSMENT IN REMISSION CRITERIA FOR RHEUMATOID ARTHRITIS IN TERMS OF 68/66 JOINT COUNTS
Authors: T. Nishino, S. Tohma, T. Matsui
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> One rationale for including patient global assessment (PtGA) in Boolean remission is that PtGA ≤1 reduces the probability of joint findings outside the 28 joints and complements the limitations of 28-joint count assessment [1]. Meanwhile, the criterion of PtGA ≤1 has been questioned, leading to establishment of Boolean2.0 or proposal of 3V-remission [2-3]. However, the significance of PtGA as a complement to the limitations of the 28-joint assessment has been forgotten. <h3>Objectives</h3> This study aimed to evaluate the discriminative power of PtGA for the presence of joint findings outside the 28 joints within the framework of Boolean2.0 and 3V-remission in the real-world setting. <h3>Methods</h3> We analyzed 8,684 patients with rheumatoid arthritis who achieved 3V-remission (28-tender joint count (TJC), 28-swollen joint count (SJC) and C-reactive protein (mg/dL) all ≤1) registered in the National Database of Rheumatic Diseases in Japan (NinJa) in 2020, a large observational database. Based on TJC68 and SJC66, patients were divided into two groups of patients with and without joint findings outside the 28 joints (JFO28). The values and distributions of PtGA were compared between the two groups, and the positive likelihood ratio for no findings outside the 28 joints was calculated, varying cutoff values of PtGA. Receiver Operating Characteristic (ROC) analysis was performed to assess the discriminative power of PtGA for the presence of JFO28 and optimal cut-off value. <h3>Results</h3> Among 8,684 patients, 6,901 were patients without JFO28 and 1,783 were patients with JFO28. The values of PtGA were significantly higher in patients with JFO28 (the difference of 25% trimmed mean, 1.12 [95% CI, 1.01 to 1.24]). However, the distribution of PtGA was largely overlapping (Figure 1). About 12%, 15%, and 21% of patients had JFO28 when the cutoff values for PtGA were 1.0, 2.0 (Boolean2.0), and none (3V-remission), respectively. The positive likelihood ratios were 1.90 and 1.44 when the cutoff values of PtGA were 1.0 and 2.0, respectively. The area under the ROC curve was 0.68 [95% CI, 0.66 to 0.69], indicating low discriminative power. The optimal cut-off value was 1.0 based on Youden index. <h3>Conclusion</h3> A cutoff value of 1.0 for PtGA seems reasonable in terms of 68/66 joint findings. It may be pragmatic to evaluate PtGA and joint findings separately in accordance with the concept of dual target therapy because PtGA has low discriminative power for the presence of JFO28 in patients achieving 3V-remission. However, our results suggested that there is a need to extend the criteria for joint assessment in 3V-remission to 68/66 joints, considering not a few patients had JFO28 even if they had reached 3V-remission. <h3>References</h3> [1]Felson DT, <i>et al</i>. Arthritis Rheum 2011;63(3):573-86. [2]Studenic P, <i>et al</i>. Ann Rheum Dis 2023;82(1):74-80. [3]Ferreira RJO, <i>et al</i>. Ann Rheum Dis 2021;80(3):293-303. <h3>Acknowledgements</h3> The authors would like to acknowledge all investigators in the National Database of Rheumatic Diseases in Japan (NinJa) in 2020. We also acknowledge Akiko Komiya, who curated the NinJa database, and Satomi Hanawa, who assisted administrative work. <h3>Disclosure of Interests</h3> Takahiro Nishino: None declared, Shigeto Tohma Speakers bureau: Pfizer Japan inc., Abbie Japan Co., Ltd., Eisai Co., LTD., Janssen Pharmaceutical K. K., Celltrion healthcare Japan Co., Ltd., Consultant of: Mitsubishi-Tanabe Pharma Co., Grant/research support from: Chugai Pharmaceutical Co., LTD., Mitsubishi-Tanabe Pharma Co., Abbie Japan Co., Ltd., Toshihiro Matsui Speakers bureau: AbbVie, Asahikasei Pharma Corp., Astellas, Chugai Pharmaceutical Co, Ltd., Eisai Co., Ltd. Eli Lilly Japan, Ono Pharmaceutical Co., Ltd., Pfizer Japan Inc., Grant/research support from: Asahikasei Pharma Corp., Chugai Pharmaceutical Co, Ltd.